Dana Center for Preventive Ophthalmology, The Johns Hopkins University School of Medicine Wilmer Eye Institute, Baltimore, Maryland, USA.
Ophthalmology. 2013 Aug;120(8):1571-9. doi: 10.1016/j.ophtha.2013.01.025. Epub 2013 Apr 16.
To report the 2-year incidence of raised intraocular pressure (IOP) and glaucomatous optic nerve damage in patients with uveitis randomized to either fluocinolone acetonide (FA) implants or systemic therapy. Secondarily, we sought to explore patient and eye characteristics associated with IOP elevation or nerve damage.
A randomized, partially masked trial in which patients were randomized to either FA implants or systemic therapy.
Patients aged ≥ 13 years with noninfectious intermediate, posterior, or panuveitis active within the prior 60 days for which systemic corticosteroids were indicated were eligible.
Visual fields were obtained at baseline and every 12 months using the Humphrey 24-2 Swedish interactive threshold algorithm (SITA) fast protocol. Stereoscopic optic nerve photos were taken at baseline and at 3-, 6-, 12-, and 24-month follow-up visits. Masked examiners measured IOP at every study visit.
Glaucoma was diagnosed based on an increase in optic nerve cup-to-disc ratio with visual field worsening or increased cup-to-disc ratio alone, for cases where visual field change was not evaluable, because of missing data or severe visual field loss at baseline.
Most patients were treated as assigned; among those evaluated for glaucoma, 97% and 10% of patients assigned to implant and systemic treatment, respectively, received implants. More patients (65%) assigned to implants experienced an IOP elevation of ≥ 10 mmHg versus 24% assigned to systemic treatment (P<0.001). Similarly, 69% of patients assigned to the implant required IOP-lowering therapy versus 26% in the systemic group (P<0.001). Glaucomatous optic nerve damage developed in 23% versus 6% (P<0.001) of implant and systemic patients, respectively. In addition to treatment assignment, black race, use of IOP-lowering medications, and uveitis activity at baseline were associated with incident glaucoma (P<0.05).
Implant-assigned eyes had about a 4-fold risk of developing IOP elevation of ≥ 10 mmHg and incident glaucomatous optic neuropathy over the first 2 years compared with those assigned to systemic therapy. Central visual acuity was unaffected. Aggressive IOP monitoring with early treatment (often including early filtration surgery) is needed to avoid glaucoma when vision-threatening inflammation requires implant therapy.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
报告葡萄膜炎患者随机接受氟轻松醋酸酯（FA）植入物或全身治疗后 2 年内眼压（IOP）升高和青光眼视神经损伤的发生率。其次，我们试图探讨与眼压升高或神经损伤相关的患者和眼部特征。
一项随机、部分掩蔽试验，患者被随机分配到 FA 植入物或全身治疗组。
年龄≥13 岁、患有非传染性中间、后部或全葡萄膜炎，且在过去 60 天内有全身皮质类固醇指征的患者符合条件。
使用 Humphrey 24-2 瑞典交互式阈值算法（SITA）快速方案在基线和每 12 个月进行视野检查。在基线和 3、6、12 和 24 个月的随访时拍摄立体视神经照片。在每次研究访视时，有经验的检查者测量眼压。
根据视神经杯盘比的增加伴有视野恶化或单独的杯盘比增加诊断青光眼，对于因数据缺失或基线时严重视野丧失而无法评估视野变化的病例。
大多数患者按治疗方案接受治疗；在接受青光眼评估的患者中，分别有 97%和 10%接受植入物治疗的患者和全身治疗的患者接受了植入物。与全身治疗组相比，更多接受植入物治疗的患者（65%）发生眼压升高≥10mmHg（P<0.001）。同样，与全身治疗组相比，69%的植入物治疗组患者需要使用眼压降低药物（P<0.001）。植入物组和全身治疗组分别有 23%和 6%的患者发生青光眼性视神经损伤（P<0.001）。除治疗分配外，黑种人、使用降眼压药物和基线时的葡萄膜炎活动与新发青光眼有关（P<0.05）。
与全身治疗相比，植入物治疗的眼在最初 2 年内发生眼压升高≥10mmHg和发生青光眼性视神经病变的风险约增加 4 倍。中央视力不受影响。需要进行积极的眼压监测和早期治疗（通常包括早期滤过手术），以避免在需要植入物治疗时因威胁视力的炎症而导致青光眼。
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